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Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS), announced $162 million in awards created to help states advance the meaningful use of health IT through state health information exchange. The awards are part of a $2 billion effort, funded by the American Recovery and Reinvestment Act of 2009, to advance health IT and achieve the use of electronic health records for every citizen by 2014.

In the HHS press release, Secretary Sebelius stressed the importance of these investments to “unleash the power of health information technology to cut costs, eliminate paperwork, and help doctors deliver high-quality, coordinated care to patients.” Secretary Sebelius also emphasized the critical role that states play in securing the exchange of electronic health records between providers and hospitals. A fully developed health information exchange serves as a stepping stone to enable eligible healthcare providers to receive incentive payments under the Medicare and Medicaid for the meaningful use of health IT.

The $162 million in awards will be given to 16 states and state designated entities (SDEs) to assist non-proprietary health information exchange. After this most recent award, all states have now been awarded funds to begin to advance the meaningful use of health IT and facilitate state health information exchange.

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The American Hospital Association (AHA) submitted comments to CMS on the proposed definition of “meaningful use” of Electronic Health Records (EHR). The Health Information Technology for Economic Clinical Health (HITECH) Act contains an EHR Incentive Program. That program is designed to encourage eligible providers to make “meaningful use” of EHR technology. The proposed rule defines “meaningful EHR user” as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with the certain objectives and measures presented in the regulation. Some of the objectives include: EHR technology to improve the quality, safety, and efficiency of health care delivery and ensures adequate privacy and security protections for personal health information.

In its comments on the proposed rule, AHA believed that CMS’s definition for “meaningful use” set too high of a standard and that very few eligible hospitals would be able to meet that standard. For instance, AHA expressed concern that CMS’s method for determining eligibility would create a larger division between small and large hospitals in that there is already research suggesting that larger hospitals are better prepared to meet the meaningful use objectives.

AHA also recommended that CMS loosen its timeline for EHR implementation, including allowing hospitals to meet the meaningful use definition if they meet 25% of the objectives in 2011 or 2012.

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A New York Times article from March 15, 2010, documents the most serious problem with cuts to Medicaid payments to doctors: doctors dropping out of the program. The article focused on doctors in and around Flint, Michigan.

According to the article, in 2008 Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare. Michigan, at 63 percent, had the sixth-lowest rate in the country. However, that low ranking does not even take into account the 8 percent Medicaid payment cut implemented last fall in Michigan.

To add to the strain on doctors that accept Medicaid, Michigan’s Governor Jennifer Granholm, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, the Governor has warned that the state may have to reduce Medicaid payments by 11 percent.

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The U.S. Department of Health and Human Services awarded the Michigan Department of Community Health (MDCH) and the Michigan Department of Information Technology (MDIT) a $14.9 million grant to encourage the expansion and success of health information technology (HIT) in Michigan.

The funds, provided through the American Recovery and Reinvestment Act of 2009, will be used to create the first statewide HIT network and increase the state’s use of HIT. The state’s goal is to increase the accessibility to individual patient records and healthcare information.

To reach these goals, the state will use the grant to implement the technological infrastructure to coordinate local and regional health information exchanges, health systems, state of Michigan systems, and integrated delivery networks. Once the system is in place, healthcare providers will be able to effectively communicate and share information, increasing healthcare quality and patient safety while reducing healthcare costs.

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The Patient Protection and Affordable Care Act passed signed into law by President Obama impacts providers in several ways. One of the areas of impact to providers is the expansion of the Recovery Audit Contractor (RAC) Program.

The Act expands the RAC Program to Medicaid by requiring that each state contract with at least one RAC to identify underpayments and overpayments. These contracts must be in place no later than December 31, 2010. The Act also expands the RAC Program to Medicare Parts C and D by the end of this year.

The Reconciliation Act of 2010 may cause some changes to the Act, however, if it is passed in its current form the RAC Program will still be expanded to Medicaid and Medicare Parts C and D.

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For the first time, Michigan providers must charge patients less than the previous year for copies of medical records. The Michigan Medical Access Act of 2004 regulates the access to and disclosure of medical records. Under the Act, the Department of Community Health has the responsibility to adjust on an annual basis the fees that may be charged by a Michigan provider to any patient requesting copies of medical records. The adjustment is based on the Detroit Consumer Price Index. This year, for the first time the fee has been decreased from the previous calendar year. In CY 2009, the initial fee for copies was $22.08, but in CY 2010, the initial fee is $21.95.

For more information, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

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The Notice of Proposed Rulemaking (NPRM) was issued in order to establish programs by which health IT technologies will be tested and certified. Such programs were mandated by the HITECH Act, which provides incentive payments to providers who demonstrate meaningful use of certified electronic health record (EHR) technologies. Companion regulations have also been introduced which propose standards and criteria that will be necessary to demonstrate meaningful use and which propose the functional capabilities that EHR technologies must have in order to be eligible for certification.

The NPRM proposes a temporary certification program for EHR systems and modules, and lays the foundation for a permanent program that will eventually replace the temporary program. The temporary program is designed to ensure that certified technologies are in place so that providers may take advantage of the incentive payments at the earliest opportunity before the permanent program has been fully implemented.

The NPRM comes after the initial meaningful use NPRM and the Standards & Certification Interim Final Rule (IFR), published in January 2010. The Standards & Certification IFR establishes an initial set of standards, implementation specifications, and certification criteria for Complete Electronic Health Records (EHR) and EHR Modues for aodption by the HHS Secretary. The Certification Programs NPRM and the Standards & Certification IFR will operate jointly to create confidence in the security and effectiveness of electronic health IT produces and systems.

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A final rule published by the Department of Health and Human Services expanded the scope of the National Practitioner Data Bank to now include disciplinary information on all licensed health care professionals, including nurses, podiatrists, chiropractors, and physician assistants. Prior to this new rule, the databank, established under the federal Health Care Quality and Improvement Act of 1986, collected adverse findings only against physicians and dentists by state licensing agencies and credentialing bodies. Similar information involving other health professionals was collected in a separate reporting database.

Please see the attachment to read the final rule.

For more information, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

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On Monday March 1st, a 21% Medicare physician payment cut went into legal effect. However, the Obama administration directed Medicare billing companies to stop processing claims for 10 business days in order to provide lawmakers with extra time to create a solution. On March 2, 2010, Kathleen Sebelius, Secretary of the Department of Health and Human Services, addressed the American Medical Association (AMA) and assured members that she was committed to developing a permanent fix to the sustainable growth rate (SGR) that controls Medicare payments to physicians.

For more information, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

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On January 5, 2010, Governor Jennifer Granholm signed legislation that expands the chiropractic scope of practice in the state of Michigan. The expansion is designed to restore the scope of practice that existed prior to when the Public Health Code was rewritten. Chiropractors in Michigan may now treat neuromuscular, skeletal and joint disorders throughout the entire body.

The Public Health Code now defines the “Practice of Chiropractic” as the discipline within the healing arts that deals with the human nervous system and the musculoskeletal system and their interrelationship with other body systems. The scope of practice also now includes the diagnosis of conditions and disorders of the human musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions. To evaluate the conditions or symptoms related to these conditions, a chiropractor may order advanced radiology scans if those scans were within the scope of practice as of December 1, 2009.

For more information, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

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